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45 Cards in this Set
- Front
- Back
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what mediates the transfer of respiratory gases, water, ions and nutrients from the mother to the fetus?
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placenta
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which macronutrients get into the placenta by facilitated diffusion?
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glucose
ketone bodies |
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which macro/micronutrients are transfered across the placenta via secondary active transport?
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Vitamin C
Amino Acids |
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which macro/micronutrients are in a higher concentration on the fetal side of the placenta than the maternal side?
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Essential FA's
amino acids iron vitamin c |
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how is maternal blood affected by pregnancy?
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50% increase in blood volume
30-50% increase in cardiac volume |
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what GLUT transporters are present in the placenta?
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GLUT 1/3
have a low Km |
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what are the four macronutrients that are allowed to cross the placenta?
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glucose
amino acids essential FA's ketone bodies |
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which cytokines/hormones mediate anti-insulin effects in the mother?
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TNF-alpha
cortisol Growth Hormone Prolactin all have insulin-resistant effects: these are the key to pregnancy induced metabolic changes seen in mothers |
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what beneficial role does insulin resistance play in mothers?
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it helps keep the concentration gradient of Glu and amino acids on the mother's side high to maintain the necessary facilitated diffusion, the fetus is fed "preferentially", induces postprandial hyperglycemia and hyperinsulinemia
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what metabolic pathways are induced in the insulin resistant mother?
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ketogenesis
FA oxidation gluconeogenesis glycogenolysis |
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what is the mothers primary fuel source?
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free fatty acids
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what is the fetus' primary fuel source?
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glucose
ketone bodies |
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what underlying risk factor for insulin resistance can develop into gestational diabetes?
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obesity
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what is the optimal weight gain during pregnancy? how much of that is contributed by the growing fetus?
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optimal weight gain is 20% of IBW
around 10.5lbs of that is due to the fetus |
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any less weight gain that the optimal increases the risk of what?
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spontaneous preterm delivery
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what does weight gain over 35lbs increase the risk for?
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preeclampsia (high BP and proteinuria in mothers)
HTN cesarean birth Macrosomia Neonatal seizures Infant hypoglycemia |
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the incidence of what two risk factors for pregnant mothers increases with every 5-7 point increase in BMI?
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preeclampsia
HTN |
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what is the relationship between BMI and how much weight a mother should gain during pregnancy?
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there is an inverse relationship between BMI and weight gain
if you have a high BMI you shouldn't gain much weight, vise versa |
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what are the risks for newborns with maternal obesity?
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LGA (large for gestational age)-develop macrosomia, hyperglycemia/insulinemia
2-fold increase in NTD's not related to folate deficiency |
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what are two risk factors of the mother for the offspring developing obesity?
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thrifty metabolic phenotypes (low birth weight infants, below 2500g)
maternal obesity is risk factor for infant obesity |
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LBW infants that show increased weight gain during childhood are at risk for what?
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metabolic syndrome
central obesity insulin resistance diabetes type 2 CVD |
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when are folate requirements the highest?
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during the first month
supplements help prevent NTD's (hydrocephalus, spina bifida, anancephaly) |
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what does low folate levels cause?
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decreased nucleotide synthesis
increased levels of homocysteine (increased oxidative stress? increased risk for atherosclerosis?) |
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when is recommended for folate supplementation?
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recommended that all women of child-bearing age take a folate supplement to decrease risk of NTD's, isolated cleft lip with or without cleft palate
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is iron supplementation needed? if so how much? what are the benefits?
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yes iron supplementation is needed, the RDA for pregnant mothers is doubled during pregnancy
decreases preterm births, increases birth weight |
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how does the placenta get iron?
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placenta gets iron by internalizing maternal transferrin
fetal iron uptake is independent of maternal iron status iron absorption increases in the third trimester, even w/o supplementation |
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what are the uses of iron during pregnancy?
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maternal Hb (for the blood volume expansion)
placental development fetal Hb fetal iron stores fetal heme/enzymes |
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what helps with the development of the gray matter the the cerebral hemispheres?
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long chain omega 3 FA's
(DHA, EPA) DHA is the most abundant in gray matter fetal omega 3 status is DEPENDENT on maternal omega 3 status |
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what are the benefits of omega 3's for fetus's?
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decreases preterm birth rate
decreases LBW decreases risk of preeclampsia helps prevent decrease in IQ's of children between 6 mo and 8 yo |
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what are the fish associated with high levels of mercury?
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Shark
Tilefish Swordfish King Mackerel |
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what is more important, trying to avoid fish with high mercury levels or to try and maintain high intake of healthy FA's?
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maintain high intake of healthy FA's
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what is RDA of calcium for pregnant women?
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the RDA doesnt change during pregnancy
women are always encouraged to increase their calcium intake b/c they never get enough from diet |
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how does pregnancy affect calcium homeostasis?
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pregnancy increases calcium absorption b/c of increases in estrogen and Vit D
bone mineralization decreases |
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what are the benefits of maintaining healthy, RDA calcium levels during pregnancy?
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decreases HTN in offspring
decreases preeclampsia in mothers |
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how does the RDA for zinc change during pregnancy?
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the RDA is increased by 35%
zinc is required for DNA pol's, protein synthesis, DNA synthesis, cell division no data supporting benefits of zinc supplementation during pregnancy |
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how would excess Vit A intake affect pregnancy?
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excess Vit A is teratogenic to the fetus during the first month of gestation
Upper limit is 10,000IU/day associated with spontaneous abortions, MR, CNS malformations, Microtia, micrognathia, cleft palate |
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what must women on synthetic retinoids also be taking?
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birth control
synthetic retinoids (i.e. Accutane) are teratogenic |
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what would a Vit C deficiency cause?
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premature rupture of membranes (PROM)
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how is the RDA for Vit C affected by pregnancy?
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the RDA is increased by 10mg/day
avg adult woman usually meets this criteria so supplementation isn't needed, but has been shown to help avoid preeclampsia and HTN |
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how does smoking affect the RDA for Vit C during pregnancy?
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it increases the RDA of Vit C
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how does smoking affect fetal nutrition?
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smoking decreases fetal nutrition in dose dependent manner by causing vasoconstriction
smokers have 10% reduction in oxygen carrying capacity |
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what some risks for the offspring from mothers who smoke during pregnancy?
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LBW
15% of preterm births are attributable to smoking increases risk of offspring being obese |
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describe fetal alcohol syndrome
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1/1000 births
common in women consuming 6 or more drinks per day women drinking over 2 drinks per day are at increased risk |
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what are some abnormalities associated with FAS?
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face (epicanthal folds, micrognathia, thin upper lip)
heart CNS (MR, memory problems) Skeleton (microcephaly) |
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what are some pregnancy risk factors?
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adolescence
anemia multiple gestation medical illness medication that inteferes w/ absorption of vitamins/minerals obesity underweight smoking alcohol abuse low socioeconomic status |
